TY - JOUR
T1 - Recurrence rate after loop electrosurgical excision procedure (LEEP) and laser Conization: A 5-year follow-up study.
AU - Bogani, Giorgio
AU - DI Donato, Violante
AU - Sopracordevole, Francesco
AU - Ciavattini, Andrea
AU - Ghelardi, Alessandro
AU - Lopez, Salvatore
AU - Simoncini, Tommaso
AU - Plotti, Francesco
AU - Casarin, Jvan
AU - Serati, Maurizio
AU - Pinelli, Ciro
AU - Valenti, Gaetano
AU - Bergamini, Alice
AU - Gardella, Barbara
AU - Dell'acqua, Andrea
AU - Monti, Ermelinda
AU - Vercellini, Paolo
AU - Fischetti, Margherita
AU - D'Ippolito, Giovanni
AU - Aguzzoli, Lorenzo
AU - Mandato, Vincenzo D.
AU - Carunchio, Paola
AU - Carlinfante, Gabriele
AU - Giannella, Luca
AU - Scaffa, Cono
AU - Falcone, Francesca
AU - Borghi, Chiara
AU - Ditto, Antonino
AU - Malzoni, Mario
AU - Giannini, Andrea
AU - Salerno, Maria Giovanna
AU - Liberale, Viola
AU - Contino, Biagio
AU - Donfrancesco, Cristina
AU - Desiato, Michele
AU - Perrone, Anna Myriam
AU - Dondi, Giulia
AU - De Iaco, Pierandrea
AU - Leone Roberti Maggiore, Umberto
AU - Signorelli, Mauro
AU - Chiappa, Valentina
AU - Ferrero, Simone
AU - Sarpietro, Giuseppe
AU - Matarazzo, Maria G.
AU - Cianci, Antonio
AU - Bosio, Sara
AU - Ruisi, Simona
AU - Guerrisi, Rocco
AU - Brusadelli, Claudia
AU - Mosca, Lavinia
AU - Tinelli, Raffaele
AU - DE Vincenzo, Rosa
AU - Zannoni, Gian Franco
AU - Ferrandina, Gabriella
AU - Petrillo, Marco
AU - Dessole, Salvatore
AU - Angioli, Roberto
AU - Greggi, Stefano
AU - Spinillo, Arsenio
AU - Ghezzi, Fabio
AU - Colacurci, Nicola
AU - Muzii, Ludovico
AU - Benedetti Panici, Pierluigi
AU - Scambia, Giovanni
AU - Raspagliesi, Francesco
N1 - Place: United States
PY - 2020/12/1
Y1 - 2020/12/1
N2 - OBJECTIVE: Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+). METHODS: This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. RESULTS: Overall, 2966 patients had conization over the study period, including 567 (20 and 2399 (80 patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (952.01,7.21); p textless 0.001) and HPV persistence (HR:1.81 (951.11,2.96); p textless 0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2.2. The risk of having persistence of HPV was similar between the two groups (15.01.6p = 0.256). Five-year recurrence rate was 8.1 respectively (p = 0.023). HPV persistence was the only factor associated with [5-]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001). CONCLUSIONS: HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia.
AB - OBJECTIVE: Conization aims to remove pre-neoplastic lesions of the uterine cervix. Several techniques for conization have been compared, but evidence regarding the most effective therapeutic option is scant. Here, we aimed to compare the recurrence rate following laser conization and loop electrosurgical excision procedure (LEEP) in patients with high-grade cervical dysplasia (HSIL/CIN2+). METHODS: This is a retrospective multi-institutional study. Medical records of consecutive patients with HSIL/CIN2+ undergoing conization between 2010 and 2014 were retrieved. A propensity-score matching (PSM) was applied in order to reduce allocation bias. The risk of developing recurrence was estimated using Kaplan-Meir and Cox hazard models. RESULTS: Overall, 2966 patients had conization over the study period, including 567 (20 and 2399 (80 patients having laser conization and LEEP, respectively. Looking at predictors of recurrence, diagnosis of CIN3 (HR:3.80 (952.01,7.21); p textless 0.001) and HPV persistence (HR:1.81 (951.11,2.96); p textless 0.001) correlated with an increased risk of recurrence. After applying a PSM we selected 500 patients undergoing laser conization and 1000 undergoing LEEP. Patients undergoing LEEP were at higher risk of having positive surgical margins in comparison to patients undergoing laser conization (11.2.2. The risk of having persistence of HPV was similar between the two groups (15.01.6p = 0.256). Five-year recurrence rate was 8.1 respectively (p = 0.023). HPV persistence was the only factor associated with [5-]year recurrence after both laser conization (p = 0.003) and LEEP (p = 0.001). CONCLUSIONS: HPV persistence is the only factor associated with an increased risk of recurrence after either laser conization or LEEP. Owing to the lack of data regarding obstetrical outcomes, we are not able to assess the best therapeutic option for women with cervical dysplasia.
M3 - Article
JO - Gynecologic Oncology
JF - Gynecologic Oncology
SN - 0090-8258
IS - 3
ER -